Provider Demographics
NPI:1790714004
Name:RAY, KENNETH PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PATRICK
Last Name:RAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 THORNTON PKWY
Mailing Address - Street 2:SUITE 178
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2166
Mailing Address - Country:US
Mailing Address - Phone:303-254-8430
Mailing Address - Fax:303-254-8235
Practice Address - Street 1:550 THORNTON PKWY
Practice Address - Street 2:SUITE 178
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2100
Practice Address - Country:US
Practice Address - Phone:303-254-8430
Practice Address - Fax:303-254-8235
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU19542Medicare UPIN
COK2913Medicare ID - Type Unspecified